Wonderful Smells Bring Back Memories

Of all the senses, smell is the sense that is best at bringing back memories. When you smell a certain scent it feels as though you slipped back in time and that you are actually at that scene again. Hale Makua Wailuku resident enjoy baking cookies and cinnamon bread. The aroma’s triggered fond memories from their past and added a reminisce element to the baking program.

Pic#1 From left Patrick Kato, Myra Yanigihara, Mitsue Nakahashi, Julita Kaiama, Doris Morisaki

Pic#2 Cookie and cinnamon bread with Myra and Mitsue in the background

Residents Celebrate February Birthdays

The Plunkers play music and perform the hula in honor of Hale Makua Kahului residents' February birthdays. Every month one day of the month is set aside to celebrate all of the residents who have birthdays during that month. Residents enjoyed cake and punch, and are given a lei on their actual birthday.

More Spontaneous Moments

Activities team member Maile Licos uses a ball to work with residents on motor and cognitive skills. The ball is covered in writing with topics and questions that let us get to know and interact with each other. Questions like “Describe your favorite hobbies” “Give a high 5 to the person across the room” “What do you wish for”.

Spontaneous Moment

Lynsey, Hale Makua Wailuku Activities Director, shared that today volunteers Wesley and Maile came to visit and talk story with our residents. They were helping route residents to the dining room for lunch and on impulse grabbed a ukulele and serenaded the residents during lunch. Residents Henry Kaina (in back) and Eileen Kailihou (front) sang along with them.

Spreading the Word About Luana

One of the Luana Core team's goals since 2009 has been to educate all of Hale Makua Health Services 500+ employees about Luaua. The Core Team has always agreed that getting employee buy-in is critical to the success of Luana, but has struggled with how to orient so many people to Luana and get them to really understand why this initiative is vital to the organization and our efforts in culture change.

While 40 employees under went the two-day Eden Alternative training to become certified, the vast majority of staff members are in various stages of how familiar they are with Luana, starting at knowing nothing, to being fairly familiar with the plagues of loneliness, helplessness and boredom. Many of the challenges that we've faced with moving forward with Luana have been with employees understanding the concept and buying into it. As you can imagine, it is very difficult to get over 500 employees on board if they're not really sure what Luana is about and how it benefits the residents as well as themselves.

I am happy to announce that we are on our way to educating all of our employees, starting with today's presentation to our Leadership Team, which consists of the organizations' managers. Joyce, Saundra and Ted of the Luana Core Team unveiled the Luana staff education presentation, which we are targeting to have presented to all employees by May 2010. The goal is to get all employees familiar with the basic principles of Luana, the three plagues, and the antidotes to the plagues, as well as share stories and examples of some of the antidotes in action.

Cooking for Chinese New Year

Kung Hee Fat Choy! Today residents celebrated Chinese New Year with freshly made crispy won tons. Residents Roberta Kapuaala and Bruno Wong, with Activities Assistant May Cordero, helped to prepare the won tons for frying before being served to their fellow residents.

The Joy of Gardening

Ella Rosetes from the West Neighborhood shared that since Kaiser Permanente's Martin Luther King Day of Service on January 18, 2010, several residents have been tending their herb and vegetable garden. One resident who used to grow lettuce on her farm was particularly excited about the prospect of being able to grow lettuce at her home again. She is seen regularly in the garden, enjoying pulling weeds,watering and fertilizing often for hours at time.

Pictured below is a resident tending to the rows of lettuce in the West Neighborhood resident garden. Also shown are before and after photos of the West Neighborhood courtyard with the Kaiser physicians, staff and their families hard at work.

Hale Makua Wailuku Celebrates Valentine's Day

On February 12th, Hale Makua Wailuku residents and staff celebrated Valentine's Day with a special lunch and dancing.

Photos:

• Activities Director, Lynsey, dancing with residents Zosima Medeiros and "Chico" Cruz
• Residents enjoy Valentine's lunch with music by Randall and Frank
• Resident Henry Kaina enjoys a Valentine's ice cream sundae
  

2nd Annual Miss Sweetheart Pageant

On February 12th, former Hana resident Alexandria Helm, Miss Pikake, was crowned Hale Makua Kahului's Miss Sweetheart 2010. Miss Pikake beat out seven other contestants including first runner-up, Marilyn Mitchell, Miss West, and second runner-up, Gloria Distefano, Miss North.

Alexandria, known to her friends as Ali, worked as a privates Home Nurse for 10 years then moved on to work at Malulani Hospital, which is now Hale Makua Wailuku. After leaving Malulani Hospital Ali worked at Kaunoa Senior Center for another 10 years. In 1932, she and her husband were the very first couple to be married at Christ the King Church in Kahului.

Photos:

• MC Brian Nagami asks 2009 Miss Sweetheart winner, Marion Watanabe, how she felt about making the front page of The Maui News for winning last year's pageant
• 2010 Miss Sweetheart, Alexandria Helm, waves to her adoring fans, and is escorted by Activities Assistant, May Cordero
• 2010 Miss Sweetheart, Alexandria Helm, pictured center with first runner-up Marilyn Mitchell on the left and second runner-up Gloria Distefano on the right
  

What is Resident-Directed Care?

In my last couple of postings I wrote about resident-directed care, also known as person-centered care. For those who may not be familiar with what resident-directed care is, I thought I'd try to give readers a short explanation and a few examples in this posting.

Resident-directed care is addressed in Eden Alternative Principle #8: "An Elder-centered community honors its Elders by de-emphasizing top-down bureaucratic authority, seeking instead to place the maximum possible decisions-making authority into the hands of Elders or into the hands of those closest to them." Please note that I use the word "residents" instead of the Eden Alternative word "Elders" as I believe that "residents" is all encompassing of the individuals we serve since not all of the people who live at Hale Makua would consider themselves to be an "elder".

How we refer to people who reside at Hale Makua has also been a hotly debated topic by the Luana Core Team. Should we use the word "Elders" as the Eden Alternative does, or is "residents" more appropriate for the diversity ages of those who live here. In the end we decided that the most Luana thing to do would be to place the "decision-making authority" in the hands of the residents.

Another example of person-centered care is something as simple as letting residents choose their afternoon activity. Last week Wednesday I had asked the Wailuku Activities Director, Lynsey, to take some photos of the residents making bread, which I thought was the scheduled afternoon activity. Of course with my one track food mind I read "bread making", not "bead making", where residents make jewelry from beads. Lynsey went on to explain that the residents had decided that they would rather sing karaoke instead of making beaded jewelry.

My final example of resident-directed care can be found in our Gardenia Neighborhood, where short-stay/rehab residents can order room service.The Gardenia Neighborhood has menus with a variety of food options and a phone that connects directly to the kitchen. Residents can order from the menu and have items delivered directly to their room.

Culture Change Through Dining

Last week I sat in on a webinar put on by the Eden Alternative, which focused on various dining topics. The moderator recommended that we start by asking residents where they want to start with dining. We can facilitate this process by helping residents to understand what's possible with dining. Asking questions like "what things are important to you when you eat?" and "What experience do you want from dining?" The goal being that resident dining options reflect what RESIDENTS want, not what we think residents want.

Dining programs will vary from one campus to the next depending on the structural layout of the dining area(s) and the number of people living and working within the community. One of the keys to a successful dining program is educating the dining team about culture change, after all we cannot expect culture change to take place if the individuals we're asking to implement it don't know what it is or why we're doing it.

The below are various types of dining programs. Dining programs may also be a hybrid of the two or more of the types of dining service, designed to best fit residents needs and desires.An example of a hybrid dining program is to have a menu that is served every day, plus some menu choices that change daily and breakfast and salad bars.

• Limited Choice Dining:This dining style is what we have now for lunch and dinner tray service.
  
• Table / Menu Service:This type of service would be most like a restaurant, where residents order off a menu and are waited on at a table. Table/menu service also gives us the ability to gauge what dishes/foods residents like by what items are most frequently ordered.
  
• Buffet Dining:This type of dining offers residents a variety of food choices. It also reduces food costs and waste, and is easy to theme. Our continental breakfast could be considered a type of buffet dining in each of the neighborhoods since residents have the ability to select what they want to eat from set options.
  
• Family-Style Dining: This dining style enables residents to choose what they want to eat and their portion sizes. It is also conducive to relationship building as residents are able to sit around a table and converse with each other.
  
• In-Room Dining: This type of dining most closely resembles hotel room service where residents are able to order off a menu and are served in their own rooms. This is one dining option where tray service would be appropriate.
  

Dining options will also depend on the abilities of residents. Residents should be encouraged to help themselves even if it's just for a portion of the meal service, like being able to get their own beverages or serving themselves during family-style dining. Some other ideas for giving residents the opportunity to make choices about what they eat and drink include:

• Having a variety of beverage choices available in the dining room all day. Beverage selections would be based on resident needs.
• Putting Lazy Suzannes with a variety of condiment choices on dining tables.
• Exposing residents to new food industry trends such as the cafe experience and juice bars.
  

Resident-Directed Care: The Culture-Change Movement

Continuing on with the idea of creating more a homelike environment for residents, I'd like to share an excerpt from an article titled "Person-Centered Care for Nursing Home Residents: The Culture-Change Movement" from Health Affairs Web First, January 7, 2010 issue:

Proponents of culture change do not recommend a specific model or set of practices. Instead, they support principles governing resident care practices; organizational and human resource practices; and the design of the physical facility. According to these principles, an ideal culture change facility would feature:

• Resident direction. Residents should be offered choices and encouraged to make their own decision about personal issues like what to wear or when to go to bed.
• Homelike atmosphere. Practices and structures should be more homelike and less institutional. For instance, larger nursing units with 40 or more residents would be replaced with smaller "households" of 10 to 15 residents, residents would have access to refrigerators for snacks, and overhead public address systems would be eliminated.
• Close relationships. To foster strong bonds, the same nurse aides should always provide care to a resident.
• Staff empowerment. Staff should have the authority, and the necessary training, to respond on their own to residents’ needs. The use of care teams should also be encouraged.
• Collaborative decision-making. The traditional management hierarchy should be flattened, with frontline staff given the authority to make decisions regarding residents’ care.
• Quality improvement processes. Culture change should be treated as an ongoing process of overall performance improvement, not just as a superficial change or provision of amenities.

Author: Mary Jane Koren, M.D., M.P.H., Assistant Vice President, Quality of Care for Frail Elders, The Commonwealth Fund

CMS Guidelines Call for More Homelike Environments

The Federal and State surveyors showed up at our Kahului community this morning, so I thought that today would be as good a day as any to write about some of the changes in the Centers for Medicare and Medicaid Services (CMS) guidelines that support our efforts in creating more homelike environments through both physical environmental changes and resident-centered caregiving. The new guidelines, which went into effect on June 17, 2009, call on nursing homes to begin/continue de-institutionalizing their physical environments. CMS suggestions include:

• Eliminating overhead paging and bed/chair alarms
• Refraining from having meal service in dining rooms using trays
  
• Removing institutional signage
• Eliminating medication carts
• Reducing mass purchased furniture, drapes and bedspreads
• Eliminating large, centrally located nursing stations

It is important to note that the above are only some suggestions provided by CMS, however if a nursing home does not meet these suggestions, they will not be considered non-compliant. According to the CMS guidelines a nursing home "is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences" (F252).

CMS memo issued on April 10, 2009, which include its new interpretive guidelines for surveyors, states: "A 'homelike' or homey environment is not achieved simply through enhancements to the physical environment. It concerns striving for person-centered care that emphasizes individualization, relationships, and a psychosocial environment that welcomes each resident and makes him/her comfortable."

In addition, new CMS guidelines also call for visitors to have 24-hour access to residents, regardless of their familial relationship. I am happy to be able to say that visiting hours and visitor sign in books at both of our nursing communities were eliminated over three years ago as part of our initial Luana efforts.

These new CMS guidelines are the result of the symposium hosted by CMS and the Pioneer Network in April 2008, which focused on the impact of innovative environmental design on creating a home and community for nursing home residents. If you are interested reading the background paper from this symposium, please click on the below link:
Creating a Home in the Nursing Home: A National Symposium on Culture Change and the Environment Requirements